The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 18, 2009 #3,730 Publisher-Barry Block, DPM, JD

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Shoes in a Basket Spread Fungi: NY Podiatrist

It’s an issue as polarizing as global warming, healthcare reform, or even Sarah Palin. When it comes to gatherings at home, what’s better: shoes on or shoes off?

Dr. Howard Dinowitz

Brooklyn podiatrist, Dr. Howard Dinowitz, says a basket of communal slippers and socks means one thing to him. “I think it’s an opportunity for communal fungus,” he says. “It’s not ‘Can it happen?’ It does happen. But I’ve seen people do that at houses. They’ll put on a communal slipper that Uncle George, who’s growing potatoes between his toes, had on yesterday. You have to share that and it’s disgusting. People can also catch athlete’s foot off a bare floor that’s laden with the fungal organism.”

Dinowitz says slippers and socks need to be both laundered — and bleached — to kill contagious fungus and bacteria. But even if hosts insist their alternative footwear is fungus-free, there are many other health reasons why guests might want to remain shod, he says, including plantar fasciitis, neuropathy (a common condition among diabetics), debilitating arthritis, or overuse injuries like Achilles tendonitis. “Some conditions or disabilities absolutely require arch support,” he says. “You’re in incredible pain without it.”

Source: Diane Mapes, MSNBC [12/15/09]

Scholl, SALSA Researchers Use Cutting-Edge Walking Sensors

Researchers from Rosalind Franklin University of Medicine's Scholl College and the University of Arizona Department of Surgery's Southern Arizona Limb Salvage Alliance (SALSA) have published a pilot project that could revolutionize the way reconstructive surgery is performed in people with diabetes. "In the past, surgery designed to heal wounds or reduce the risk for development of wounds in people with diabetes has been haphazard," noted David G. Armstrong, Professor of Surgery and SALSA's Director. "This study suggests strongly that we can work toward predicting success pre-operatively."

Dr. Bijan Najafi

The study, which uses cutting-edge sensors that sample pressure points on the bottom of the foot while they walk, employs an entirely new way of analyzing the data. "We can now learn from previous works and use sophisticated algorithms to see deformities and help the surgeon plan the procedure," added Dr. Bijan Najafi, Associate Professor at Rosalind Franklin University and the lead author on this study. Armstrong concluded, "We believe that all clinics may one day have sensors like this and we can go a long way toward reducing unnecessary amputations, which occur once every thirty seconds around the world."

IL Podiatrist Holds 11th Annual Shoe Drive

Many area businesses are paying it forward this holiday season by collecting items for local charities. Dr. Tina Starkweather, local podiatrist, is conducting her 11th annual “Share Your Soles” shoe drive. As part of the program, Starkweather is collecting gently-used shoes and boots for Hope Haven and Safe Passage.

Dr. Tina Starkweather

“The shoe drive is a project we’re committed to because we know the importance of a dry, warm pair of shoes,” Starkweather said, “especially to prevent weather-related foot problems.” Starkweather said she collects shoes and boots for men, women and children. She said the program is most in need of children’s shoes. “We enjoy collecting the shoes and distributing the shoes,” Starkweather said. “The recipients are always very appreciative.”

Source: Dennis Hines, The Midweek [12/15/09]

House Okays Bill Delaying Doc Pay Cuts

The House voted 395-34 to approve a fiscal 2010 defense appropriations bill that includes a measure to stave off Medicare physician payment cuts until March 2010.

Various proposals in the House and Senate seek a more permanent fix to Medicare's sustainable growth-rate, or SGR, formula, which is based on the economy's health and has threatened payment cuts to physicians every year since 2003. Physicians, however, aren't banking on any of those proposals getting approved before Jan. 1, the date when their Medicare payments are expected to get cut by 21.2% under the SGR formula.

Source: Jennifer Lubell, Modern Healthcare [12/16/09}
 

Query: Aetrex iStep Machine

I am interested in hearing some feedback from anyone who has been using the Aetrex iStep machine for sizing and fitting for diabetic shoes. Do any of the other shoe companies have a similar product?
 
Michael Tritto, DPM, Rockville, MD

RE: Osteomyelitis Case
From: Wm. Barry Turner, BSN, DPM

This 24 y.o. IDDM young lady presented with neuropathy, but no wounds, just a complaint of a painful foot. Denies trauma. After initial x-rays, I ordered a WBC-tagged bone scan and I prescribed Flagyl, Doxycycline, and Cipro. The WBC-tagged bone scan was positive for osteomyelitis. I then had the local hospital radiologist do a needle biopsy for cultures. The patient had been on the antibiotics for two weeks by the time the needle biopsy was performed. The cultures returned-no growth for anaerobic and aerobic, but the gram stain revealed gram positive cocci. I left the patient on Cipro.

Osteomyelitis of 2nd and 3rd  Metatarsals (7/28/09 & 10/27/09)

The patient had no insurance and limited financial ability. She could not afford to stop work. Her job would not allow her to work with a cast or a foot brace. Basically, I just kept her on Cipro for 8 weeks. The bone had no immobilization at all. She did commit to wearing a "stiff" shoe. I only saw her a few times. I just think it is interesting to see how this bone infection responded to very little care. She failed to come back for her last appointment. 
 
Wm. Barry Turner, BSN, DPM, Royston, GA, claret32853@gmail.com

RE: The Prescribing of Uric Acid Lowering Drugs (Barry Mullen, DPM)
From: James J DiResta, DPM, MPH, Arnold B. Wolf, DPM

Sometimes, a person just can't hold back. I read with some amusement the recent comments re: podiatry's role in gout management. I can't imagine practicing podiatric medicine today and not feeling confident and competent to prescribe allopurinol. The lame brain excuse of leaving everything you treat to someone else who is more competent than you will leave you shining shoes! No, I take that back, a shoe shiner who shines daily is really more competent to shine shoes than you; so, you ought not shine shoes too. What kind of logic is that?

The best comment of the week, however, belongs to Barry Mullen's and I quote, "Cowboys belong on football fields and rodeos, not in our profession." Let me tell you, if it were not for the brave "cowboys" of our profession like Lowell Weil, E.D. McGlamry, Allen Jacobs, Jim Ganley, Steve Smith, Harvey Lemont, etc... where the heck would we be today? Please, keep breaking down the barriers that have stood in our way, use the education and training you've been given to move this profession forward, be smart and play smart, use restraint when needed, but for God's sake please, saddle up man and practice this wonderful profession of podiatric medicine and surgery fully.

James J DiResta, DPM, MPH, Newburyport, MA, James.J.DiResta.DMS04@Alum.Dartmouth.ORG

I personally do not hesitate intervening in an assumed case of monoarticular joint pain. As a part of the medical "team" that manages a patient, when that patient walks in your door, "you have the ball," and what are you going to do with it? As long as we practice within our scope (and capabilities), we have the opportunity to cure/manage situations such as these. As far as management, I'm careful about 1st line intra-articular injections in unconfirmed gouty arthritis (r/o septic arthritis). Medrol dosepak is usually very well tolerated (always evaluate co-morbidities). Appropriate lab work is performed initially, including CBC with differential, x-rays, ultrasound (tophi shows up nicely in chronic situations), etc. are performed as appropriately indicated. I'm fully confident in my ability to manage these patients  long-term and will modify therapy as appropriate. Referrals (PCP, rheumatology, nephrology) are always made when necessary and communication lines are kept open. Bottom line...successful gout outcomes give you another opportunity to "let your star shine."
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net

RE: Personnel Policy (Charles Morelli, DPM)
From: Pete Harvey, DPM

Dr. Morelli might check the personnel policies section of The Podiatric Practice Manual by Joseph S. Borreggine, DPM. This is an excellent customizable guide.
 
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Reporting Negative News
From: Brian Kashan, DPM

Most people do not enjoy seeing negative comments, topics, or issues on a posting forum like this. Unfortunately, the reality of our profession, as every other, has instances where people use poor judgment, make mistakes, and suffer consequences.  There may be members of our profession who live on the edge, take risks, and may dabble in some behavior that can be considered fraudulent, unethical, or outright illegal. Sometimes this is intentional, and sometimes not. It is certainly a very small percentage of a relatively small profession.
 
In addition to just reporting these cases, I hope that they would serve as a warning, promote caution, and perhaps, wake up someone who may also be acting similarly. I do not believe that anyone does these acts thinking that he will be caught. To the contrary, they think they will never be caught, that the system won't find out, that their colleagues do it and get away with it all the time. This is one of the dangers of NOT reporting this type of unfortunate news.
 
People live complicated lives. Sometimes, the pressures of these lives are overwhelming. We all may need some help, advice, or counseling at times. Also, sometimes, we may be greedy and gluttons. This does not justify committing crimes and unethical acts that result in harming ourselves, our patients, our families, and our profession. I am sure that, on at least one occasion, someone has thought  twice about doing something professionally on the edge, or maybe over that edge, after seeing one of these articles or a picture of a colleague being led away in handcuffs. If that be the case, and that person corrected his actions, then posting the negative story actually made a positive impact, and could save a lot of pain for many people.
 
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

RE: Healthcare Reform (Thomas Nolen, DPM)
From: Pat Caputo, DPM

Healthcare reform and “end of life” medical care are not mutually exclusive issues. Dr. Nolen raises an interesting point, and although he does not reference the $100,000 figure, I do not disagree with it. And it might even be true in his assessment that the $100,000 is “many times with no added quality of life, only miserably extended life. There is no limit to how much money can be spent on each patient.”

My questions: Who decides on end of life care, and more importantly who decides...

Editor's note: Dr. Caputo's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=31275&start=1

EQUIPMENT FOR SALE - DIAGNOSTIC ULTRASOUND

MINDRAY DP-6600 Diagnostic Ultrasound for sale. 7.5 Mhz linear transducer. Like new condition, less than 2 years old. Comes with mobile stand. Contact robdaughertyddd@yahoo.com or 573-979-1809 for further information.

PRACTICE FOR SALE – NE OHIO

Long established general practice. Grossing $300,000 annually with very little surgery. Modern, well equipped office in desirable location. Large diabetic patient base with DME. Excellent referrals with over 500 new patients per year. Great growth opportunity for surgically trained podiatrist. Owner will stay to introduce. Email: docjoc227@hotmail.com

ASSOCIATE POSITION - HUDSON VALLEY, NY

Excellent opportunity for a three-year surgically trained foot and ankle physician. We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM with ability, and a desire to teach and take ER call. If interested, please forward CV to: healthyfeet4ever@yahoo.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

EQUIPMENT FOR SALE

X-Cel MB-700 X-ray unit, All-Pro Processor, and Anodyne unit.
731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. Fax cover letter & CV to (843) 208-3348 or E-mail to melissafoot@pol.net

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

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